An Interprofessional Approach to Community Health and Nutrition at an Emergency Shelter

Background The unmet social, economic and healthcare needs of the homeless are of growing concern to both public and private sectors in our community as steep costs are incurred when severely debilitated homeless persons cycle repeatedly through hospitals, emergency rooms, treatment centers and jails. Local problem In recent years, the communities of Harrisonburg/Rockingham County have seen a growth in homelessness due to low wages, a lack of available affordable housing, and unemployment. The number of homeless adults and children in this community has increased 59% since 2008. The Salvation Army in Harrisonburg has an emergency shelter for up to 40 individuals, including families, and has historically been served by the Healthcare for the Homeless Suitcase Clinic (SC), a unique healthcare delivery model that addresses the unconventional and complex health concerns of homeless adults. Shelter circumstances prevented the SC from offering services for a stint prior to September 2016. At that time, the opportunity to reconvene services was available, although a volunteer provider was still needed. The purposes of this Interprofessional Student Engaged Community Clinic project were to: 1). provide medical care to homeless clients sheltered at the Salvation Army; 2) offer additional clinical training sites for nursing, physician assistant and dietetic students; 3) provide first-hand interprofessional practice experiences for clinical students; 4) model and encourage community engagement with the local community partners; and 5) evaluate the beliefs, behavioral and attitudes that underlie interprofessional socialization and collaborative practice. Interventions Nursing and physician assistant students worked in teams with clinical faculty members to conduct weekly clinics, which included making the initial contact with individuals at the Salvation Army shelter and completing a thorough background history. Concurrently, Dietetics students conducted a needs assessment of the emergency shelter residents that informed the development of group programming focused on mindful eating and eating enjoyment. Additionally, a student organization offered education on chronic disease-related dietary considerations by modifying a free meal each month. Acute and chronic medical needs, nutritional education needs and opportunities to support healthful initiatives within the shelter were identified and addressed by the Nursing, Dietetics, and Physical Assistant and students, in collaboration with on-site faculty. Methods Surveys administered pre- and post- to assess student learning included the Interprofessional Socialization and Valuing Scale (ISVS; n=24 items) and Attitudes Towards the Homeless Inventory (ATHI; n=11 items). Qualitative data were collected through open-ended survey items, course assessments, and student meetings. Results Based on completed surveys (n=20), ISVS scores improved pre- to post- from 5.9 to 6.3. Similarly, ATHI scores increased from 2.8 to 2.9. Themes for working in interprofessional teams included understanding roles of members, value for better patient care, and importance of communication. Themes related to working with the homeless were increased comfort with communication, providing care for the whole person, and inequity of health care. Students suggested formal orientation to peers and the setting in future courses. Conclusions/Implications Nursing, Dietetics and Graduate Physician Assistant students were able to apply their knowledge and skills to practice within an interprofessional healthcare workforce caring for homeless persons. Interprofessional community learning experiences with vulnerable populations can have a positive impact on student learning outcomes

Effect of Early Intervention with Combination Ledipasvir/Sofosbuvir (Harvoni®) in Patients with Chronic Hepatitis C Virus Infection

In the United States, hepatitis C virus (HCV) is the most common bloodborne infection with an estimated prevalence of 3.2 million people. Although new cases of HCV are declining since the 1980s there are still approximately 17,000 new cases diagnosed each year. There are multiple risk factors, however, in the United States the most common mode of transmission is intravenous drug use. Among infected individuals, approximately 55-85% will develop a chronic HCV infection. In this population, the risk of cirrhosis of the liver is 15-30% within 20 years and morbidity can be significant. HCV infection has become the most frequent reason for hepatologic consultation and the single leading indication for hepatic transplantation, accounting for 30% of such procedures in the United States. Until late 2013, the treatment of choice for chronic HCV was pegylated interferon-α plus ribavirin, which achieved a cure rate of 54%-63%. Recently, novel antiviral drugs that specifically target HCV have provided better options in HCV treatment. Use of ledipasvir, an HCV NS5A replication complex inhibitor in combination with sofosbuvir, a nucleotide analog HCV NS5B polymerase inhibitor, in patients with chronic HCV, achieves high rates of sustained viral response (SVR) with just 12-weeks of treatment. A fixed-dose combination of ledipasvir-sofosbuvir (90mg/400mg), or Harvoni® was approved for treatment of chronic HCV genotypes 1,4,5, and 6. Although extremely successful, the use of this medication is inhibited by high costs, upwards of $90,000 for each 12-week treatment

Effects of a robotic cat on agitation and quality of life in individuals with dementia in a long-term care facility

Study Objective: The purpose of this study is to determine whether introducing a robotic companion cat into a long term care facility may improve affect and, subsequently, increase participation for residents with dementia, and to determine potential benefits for caregiver roles and relationships with individuals with dementia. Background: The number of people with dementia is growing, and the behavioral and psychological side effects are negatively affecting the quality of life for these people as well as their caregivers. Additional research is needed to help develop and confirm the use of nonpharmacological treatment for dementia with therapeutic robots. Study Subjects: Research was conducted at Bridgewater Retirement Community in the complete-care nursing households. We recruited 11 participants, ages 81-95,and all data was collected within each resident’s household and common area. All participants had a diagnosis of dementia, resided in a long--term care facility, and relied on assistance from caregivers for some or all activities of daily living. Methods:Data was collected using a mixed-methods design that combined both quantitative and qualitative measures. Quantitative measures included a pre and post Cohen-Mansfield Agitation Inventory (CMAI) (Appendix A), completed by the household coordinators, as well as weekly behavior log and physiological indexes (heart rate and oxygen saturation) (Appendix B), used to objectively document our observations and interactions with the cat. These measures were used to determine the efficacy of a robotic companion on agitation. Qualitative measures included weekly observational data and staff reports as well as a final questionnaire for the household coordinators to summarize their overall impression of our study on the participants. These measures were used to determine the perceived quality of life of individuals with dementia and their caregivers. Use of psychotropic and pain medication was determined by review of the Medication Dispensing Record after the data was collected . Results: We found a statistically significant reduction in agitation scores from the beginning of our study to the end, along with a statistically significant increase in oxygen saturation throughout the course of the study. There were no significant changes in heart rate from pre-intervention to post-intervention (Table 1). Qualitative data collected throughout the course of the study were sorted into categories and analyzed for emerging themes. The data for each participant for each interaction over the course of the study is displayed in Figure 1. Overall themes over the course of the study are displayed in Figure 2. We did not find any significant reduction in the use of psychotropic medications over the course of the study. The household coordinator’s responses to the final questionnaire were overwhelmingly positive and described the impact that the robotic companion cats had made on their residents and their caregivers. Conclusion: The use of robotic companion cats enhances[KEN-k1] the well-being and quality of life of individuals with dementia living in a long-term care facility by providing companionship and interaction with their environment which helps to reduce anxiety and agitation. Robotic companion cats also reduce the burden placed on caregivers by providing a nonpharmacological intervention for agitation and loneliness. Due to our small sample size, it is still difficult to draw any major conclusions about the use of nonpharmacological therapy as an adjunct to pharmacological therapy in the long term treatment of dementia. Though these effects were not seen across all participants, the researchers believe that the impact these companion cats have had on a few individuals is significant enough to prompt future research and continue exploring other non-pharmacological options for improving the day to day life of an individual with dementia. Funding for Research: Bridgewater Retirement Community provided funding to purchase the Hasbro’s Joy For All Companion Cat. The link is provided here: https://joyforall.hasbro.com/en-us/companion-cat